What's he building in there?: The uncertain future of a planned behavioral health treatment facility in Templeton

Directly across the street from Twin Cities Community Hospital on Las Tables Road in Templeton sits a field. The 3-acre parcel slopes down and southward away from the street, toward a patch where bare trees slurp up water from Toad Creek, which runs through the property—when there’s actually water.

A towering, 30-foot-tall berm runs from the road and into the middle of the property. The man-made mound was created when the hospital removed a bunch of dirt while building a new a wing. Twin Cities opened in 1977 with plans to become a regional medical center. Those plans were later realized, and the surrounding area was zoned for medical use. The strip along Las Tables Road west of Highway 101 was slowly built out with medical office suites and specialized centers, while the surrounding land was covered by houses, and also, eventually, vineyards.

But aside from recent construction of underground culverts for drainage, a joint access road currently being installed, and the mound of dirt, the lot sitting at 1155 Las Tables Road has remained untouched.

Dr. Harvey Billig, a retired ophthalmologist and one of the hospital’s original staffers, bought that piece of land in 1986. Since then, Billig—who’s also developed medical and surgery centers around California—has tried a few times to develop the site. Twice he put together plans to build an assisted living facility on the land, but neither took. The most recent attempt was approved by the county in 2007, but the then-ailing economy made getting financing impossible, and the project fizzled.

IMAGE COURTESY OF HOCHHAUSER BLATTER ARCHITECTURE AND PLANNING

AS PLANNED: Two facilities planned for Templeton have drawn a mixed response from area residents. A retired doctor who owns a 3-acre lot across from Twin Cities Community Hospital in Templeton has proposed a behavioral health hospital for Las Tablas Road (bottom left) and an assistedliving facility (upper right).

“This is the history of how it works,” Billig told New Times.

Now he’s back, and the man has a plan for two separate facilities: a 96-bed behavioral health hospital, and an approximately 66-bed memory care center. The two facilities would be separate buildings run by separate operators on separate lots, as long as the San Luis Obispo Planning Commission approves a lot split proposal that should come before commissioners sometime this spring or summer. If the lot split is approved, the project—especially the behavioral health facility—must still endure a rigorous approval and licensing process from the state, namely from California’s Office of Statewide Health Planning and Development (OSHPD).

While a lot split may be an early and rather rudimentary decision in the scheme of a specialized psychiatric health facility subject to layers of oversight and regulation, the plan seems to already be facing fierce opposition that will attempt to throw roadblocks in the way of necessary approvals.

The project has whipped a number of Templeton residents into a frenzy, and those residents are now expressing concern about what the behavioral health hospital facility—also known as a freestanding acute psychiatric hospital—will mean for the town of 7,700, people, should it be built. As these residents see it, the worst-case scenario is that the facility would become a magnet for people with mental illnesses—some presenting a danger to themselves and those around them—who are brought to the facility from surrounding counties, treated for a few days, and then allowed to walk out the front door and wander the streets of Templeton doing God knows what with no place to go.

That thought was enough to draw 300 people to a several-hours-long November 2014 meeting of the Templeton Area Advisory Group (TAAG), where, after two previous meetings on the subject, the seven-member board voted unanimously to oppose the project.

That early opposition, and what has so far been a somewhat public outcry that at times feels like suppressed panic, has pitted the construction of what many people consider to be a direly needed facility against a tightly knit community fueled by a series of worst-case scenarios that have cast a shadow over the proposal.

Why this, and why there?

As proposed, the two-story inpatient behavioral health hospital will have approximately 96 beds, distributed evenly among four different sections, two on each floor. These four areas will be designated for four different patient types: children, adolescents, adults, and geriatrics. Each section will have 20 or 21 beds, and each floor will have approximately seven swing beds. There won’t be any interaction between the four areas, and each will have a unique staff, except for maybe a few psychiatrists or doctors who go from area to area, said Mark Schneider, head of Vizion Inc. the operator Billig tapped to run the facility.

The facility would accept private insurance and Medicare. Patients would come from private referrals, or from another acute treatment center, like an emergency room or county behavioral health facility. The facility would serve a crucial role in providing somewhere for a person in a crisis situation to go, as well as stabilization and necessary care, and creating a care plan. Currently, the only facility like this is the county’s Psychiatric Health Facility (PHF, commonly called PUFF), which serves as a crisis center of sorts for patients who need acute inpatient psychiatric care. PUFF has 16 beds and often deals with people who may not have insurance and those who may be considered a danger to themselves or others.

If a person with a mental illness is determined to need inpatient care, he or she may first go to the county’s PUFF. That has limited room, however, especially for child, adolescent, or geriatric patients, leaving people with proper insurance likely transferred to a private facility.

It’s common for patients to travel outside of the county to seek necessary help. There are acute psychiatric treatment hospitals in Monterey, Santa Barbara, Ventura, San Mateo, and Santa Rosa, as well as a few in the valley. Not all facilities take children—the Ventura hospital is often full, according to Billig, so a lot of families might take their children or adolescents to a newer facility in Santa Rosa, which is a similar size as to the one proposed in Templeton.

Anne Robin, SLO County’s Behavioral Health Administrator, told New Times that PUFF sends about 350 patients a year to other facilities for treatment. These patients may be children, or adults with the proper insurance, and usually receive care for an average of seven to 10 days.

When patients have to travel, the move presents both a challenge to those providing care and a strain on family members.

“You can imagine that’s very difficult for family members to be a part of the treatment for kids if that kid is all the way in Santa Rosa,” Robin said.

At times, receiving adequate care can be out of reach, or at least complicate life.

“People with insurance in our county have a difficult time finding providers as it is,” Robin said. “So if there are more treatment centers that provide treatment, that helps everybody.”

That situation is what caught Billig’s attention: “The problem that we have in the county is that hundreds of people every year are being forced to leave the county to get inpatient care, and that’s an intolerable situation.”

The need for such a facility in the area isn’t unique to San Luis Obispo County, Billig said, because such lack of facilities is a reality in many places.

The Treatment Advocacy Center, a national nonprofit with a stated mission to eliminate “barriers to timely and effective treatment of severe mental illness,” has sounded the alarm in several reports, writing in a 2012 issue of its newsletter Catalyst: “By the beginning of 2010, there were 14.1 beds per 100,000 people nationwide, a fraction more than the 14 beds per 100,000 that existed in 1850, before Dorothea Dix and other advocates began their drive for humane treatment options for people with severe mental illness.”

In a March 2014 statement, National Alliance on Mental Illness (NAMI) Executive Director Mary Giliberti called the shortage of beds paired with a general shortage in funding for mental health services a “double whammy.” She added, “There are not enough beds. Supply does not meet demand. It is not just patients who are in crisis; it is the system as well.”

While this situation is a nationwide hardship, the bed shortage is especially chronic in California. A September 2013 report published by the California Hospital Association (CHA) titled “California’s Acute Psychiatric Bed Loss” details the decline in numbers of available beds, demonstrating a “devastating drop” that occurred over 15 years. The study documents the total number of beds at the 28 hospitals licensed as freestanding Acute Psychiatric Hospitals (at least one new hospital, in Santa Rosa, has opened since the paper’s publishing), the 22 county-run Psychiatric Health Facilities, and dedicated psychiatric units within General Acute Care Hospitals (GACHs). These numbers do not include beds from state-owned hospitals like Atascadero State Hospital, because these beds aren’t available to the general public, but are occupied by people who have received a court order or a criminal sentence.

As of 2011, California had lost almost 32 percent of the beds it had in 1995, or 3,000 beds. During that time, the state lost 44 facilities from hospitals eliminating psychiatric inpatient care units and from outright closure of hospitals. Meanwhile, California’s population continues to increase, broadening what is referred to as the patient-to-bed gap. What’s left is a ratio of 16.76 psychiatric inpatient beds per 100,000 residents, or a total 43 percent loss per capita since 1995.

The CHA paper refers to “a panel of 15 leading psychiatric experts” who determined that the minimum number of beds required to meet current needs is 50 per 100,000 residents. Depending on whom you ask, that ratio may waver between 40 to 60 beds per 100,000 residents.

While there may be some disagreement, it’s generally accepted that SLO County can use more.

“Sixteen beds in a county of 270,000 is not sufficient to meet the needs of the community,” Robin said.

Clues for concern

After the tangled ball of concerns was aired at the November TAAG meeting, several Templeton residents called to alert New Times about the facility—and the problems that they saw waiting to be exposed.

The concerns were widespread, to say the least.

IMAGE COURTESY OF HOCHHAUSER BLATTER ARCHITECTURE AND PLANNING

BIRD'S EYE VIEW: A team of developers has proposed the construction of two facilities on a 3-acre lot across the street from Twin Cities Community Hospital in Templeton. As proposed, a behavioral health hospital will face Las Tables Road, which runs horizontally along the top of the image, and an assisted living facility will be in the back. The property first must receive a lot split approval from the county.

Some callers chose to be identified only by their first names, or were ardent about staying anonymous. One caller wouldn’t reveal any information, claiming that she had to protect her children from the perpetrators of a broader conspiracy. She claimed that the perpetrators wouldn’t stop short of using Smart Meters and cell phone towers to tamper with people’s brains and drive them into these facilities, creating both a demand for treatment and an opportunity for testing and experimentation.

After the dust settled, however, a few headstrong Templeton residents have stayed focused on the project, creating a laundry list of questions that they say haven’t been answered, or at least haven’t been answered to their satisfaction. They say that the applicants’ story has changed from meeting to meeting.

“They keep telling us what we want to hear,” said Gwen Pelfrey, a Templeton resident who’s outspoken on the issue.

“Or what they think we want to hear,” added Fred Russell, another Templeton resident who joined Pelfrey and a few others to discuss their concerns with New Times.

And then, Pelfrey said, the story changes again.

The residents are cautious because aside from plans for the physical site and the upcoming hearing on a lot split, there isn’t much else that’s written in stone.

The fact that it’s a private, for-profit facility makes some people nervous. So does the idea that the proposal calls for it to be run by out-of-towners. The project does have some mysterious elements: The proposed operator, Vizion Inc., is based in Louisiana, and aside from virtually existing on paper, the company doesn’t have much of a footprint. Papers were first filed with the state of Louisiana in 2011, according to the Secretary of State’s business filings. Each of the company’s four listed officers, including the Louisiana-based Schneider, hails from a different state: Florida, Arkansas, and North Carolina. Vizion’s website is a one-page GoDaddy site with an ambiguous mission statement and a misspelled word. The “contact” link leads only to a phone number, which was disconnected all through the end of 2014 and into 2015.

These details certainly don’t help ease concerns in a community where theories are swirling around. For Pelfrey and other residents, it reeks of a group of people looking to set up a facility long enough to get it running, then flip it for a profit before skipping town.

“We don’t have anyone whose real interest is a community’s interest or a county’s interest,” Pelfrey said. “We have individuals that want to move their property.”

Schneider said that when he formed Vizion, he recruited people he’s had long working relationships with, people who have experience at several facilities throughout the states. The company is currently working on several prospects—most of them involving taking over existing facilities. Schneider couldn’t disclose where those facilities are, as the company is still in confidential contract negotiations in which the employees don’t know that the facility they work for may be up for sale.

Billig said he sought Schneider for his reputation as an effective operator, one who’s taken poorly performing facilities and turned them around.

“I was lucky to find him as a great operator, but also someone who is not afraid of California and the sequence and time it takes to get up and running,” Billig said.

As for buying and selling existing companies, that’s just part of the game.

“A new start-up company like mine can’t do all the no-vote projects,” Schneider said, referring to the inherent risk of having a project or a license denied. “You have to acquire some cash-flowing facilities in order to survive.”

California is in a unique position because in the wake of all the closures of behavioral health hospitals documented by the CHA, there isn’t much to do but build new ones from the ground up.

As for the website, Schneider will acknowledge that it’s not the best. Considering a web designer who went missing and a new one just now in the hiring process, he called it an unfortunate oversight.

“I’m 67,” he admitted. “Websites weren’t as important to me as apparently they are now.”

An unclear future

All curbside judgments aside, people critical of the project are driven by some bigger questions about what predicted changes the facility could bring to the community. These concerns are two-fold: What type of patients would be in the facility? And what would the impact be to the community?

There are two different types of psychiatric inpatient care: voluntary and involuntary. Voluntary care is given after a patient is checked in for a variety of reasons, is part of a program recommended by a physician, and is generally agreed to by the patient or legal guardian. Involuntary care occurs when someone must be placed in the facility because he or she poses a threat. Patients held in facilities in such a way are often referred to as a 5150s and are committed for a minimum of 72 hours for observation. The name is derived from Section 5150 of the California Health and Safety Code, a section created with the passage of the Lanterman-Petris-Short (LPS) Act, which dictates modern mental health commitment procedures in the event that someone needs to be held against his or her will. A facility designated to receive patients under Section 5150 is also classified as having an LPS designation.

That the proposed Templeton facility may attract people with mental illnesses who might present a danger to the community is something many residents are having difficulty accepting.

Schneider and Billig say they don’t intend the facility to take LPS-designated patients, and instead will focus on voluntary care. In addition to patients with private insurance, the facility will take Medicare beneficiaries (elderly adults), and will only take Medi-Cal when providing medically necessary inpatient services for youth. As a voluntary facility, the only adults ages 21 to 64 who would receive care would be privately insured.

A summary of the facility provided by the SLO County Behavioral Health Department’s Robin explains that it would be helpful for the county if it were to become an LPS designated facility, because then the county’s PUFF wouldn’t have such full hands.

For now, however, Schneider is sticking to plans for it be a voluntary facility.

“Our intention is to be a voluntary hospital,” he said. “We’re going to take them in and fix them up because they’re hurting, and then put them into continual care.”

There may be exceptions. If someone from Twin Cities Community Hospital is in urgent need of care, for example, he or she might come in for treatment before the next step is sorted out, though the county’s mobile crisis team will usually be the first responder.

The other cause of concern for Templeton residents is the idea that the facility, with upwards of 100 beds, will need to draw from several surrounding counties in order to stay full—because, critics say, there isn’t a simultaneous need for that many beds.

Pelfrey points to CMA’s list of beds-per-county and says that if built, this facility would put SLO County at the top of the list of beds per 100,000 residents.

“Which is pointing to the reality that this would be a regional facility,” Pelfrey said. “We’re going far beyond the county need.”

Normally people go to the population centers, where facilities exist, she said. “They don’t go from the big city to a small rural area to get that expert care.”

The possibility of importing patients who may be 5150s is the core of concern for these residents, as the influx may put a burden on the community. Pelfrey said she wants a feasibility study and a better assessment of the area’s demand for such a facility before the project moves forward.

“If this is regional and services other counties, the impact they are putting on a rural community doesn’t seem justified,” she explained.

Schneider dismissed these concerns, explaining that the facility, which needs the right economy of scale to operate, will bring the county to right around the 50 beds per 100,000 residents ratio.

Templeton resident James Jones, a retired Los Angeles Police Department captain who was a founder and chair of a Mental Health Crises Committee in Los Angeles County, is concerned that these impacts may translate to a public safety concern.

“The bigger problem is that they can come here and be released on the streets,” he said.

However, the so-called problem population worrying Templeton residents may not even be in that facility in the first place.

The SLO County BHD summary explains that whether the facility treats 5150 patients or not, “the type of individuals who seem to be generating the most neighborhood concern are the Medi-Cal (no private insurance) adults, particularly those who may be homeless (and likely discharged to the community rather than to a more stable placement). That is the one demographic that is the least likely to be a patient in the facility.”

Robin added that in most cases, there’s a plan for transporting and providing care for people after they are released from these facilities. Most of the prospective patients in this area aren’t yet adults or are elderly, and will probably have a guardian who takes them home.

Regardless of the type of patients admitted to the facility, Billig said there shouldn’t be any concern.

“I take it very seriously when people worry about security and safety, but this is a secure facility,” Billig said. “That’s not an issue, period.”

The facility’s architect, Jan Hochhauser of Hochhauser Blatter Architecture and Planning, said the facility is designed to keep people in and ensure the safety of the surrounding area, while still serving its purpose.

“The goal here is to give the environment that allows people to recover, to feel safe and secure,” Hochhauser said. “It is not a prison.”

Particularly in light of the fact that the project also has many supporters, Hochhauser and Billig see these concerns from residents as inflated and unfounded and the result of a bias against the mentally ill. Hochhauser called it a “witch hunt.”

Billig said he’s more concerned about people in the community who aren’t receiving treatment then those who are able to get treatment from a facility of this kind.

“It gets a little frustrating when people will just throw out scare tactics and try to dictate how medicine is practiced when they know absolutely nothing about it,” he said. “Let’s not stigmatize mental health care. Let’s try to work with all of the population to do the best thing possible.”